Peritoneal Dialysis in Children

Alexander, Steven R.

doi:10.1007/978-0-387-78940-8_29

Cited by 18 publications

(5 citation statements)

References 384 publications

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“…Overall, there was no difference in mortality between PD and extracorporeal RRT in both the observational studies (odds ratio (OR), 0.96; 95% confidence interval (CI), 0.53–1.71) and the 4 RCTs (OR, 1.50; 95% CI, 0.46–4.86). Three of the RCTs were conducted primarily among septic or critically ill patients (77-100% of cases). Gabriel et al ‘s randomized trial was well conducted; however, it has been criticized for flaws in randomization, inclusion criteria, and not being powered to detect a mortality difference (7).…”

Section: Adult Guidelinesmentioning

confidence: 99%

“…With only a small concentration gradient between dialysate and plasma, the transport of sodium is primarily by convection. As often occurs with acute PD, rapid cycling with hypertonic dialysis solutions to promote ultrafiltration can result in hypernatremia as a result of enhanced free water clearance secondary to sodium sieving and transport of water through aquaporin channels (95). The removal of free water is greatest during the initial 30 – 60 minutes of each exchange.…”

Section: Guideline P3: Peritoneal Dialysis Solutions For Acute Pd In Childrenmentioning

confidence: 99%

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Peritoneal Dialysis for Acute Kidney Injury

et al. 2014

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Section: Adult Guidelinesmentioning

confidence: 99%

Section: Guideline P3: Peritoneal Dialysis Solutions For Acute Pd In Childrenmentioning

confidence: 99%

Peritoneal Dialysis for Acute Kidney Injury

et al. 2014

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“…As often occurs with acute PD, rapid cycling with hypertonic dialysis solutions to promote ultrafiltration can result in hypernatremia as a result of enhanced free water clearance secondary to sodium sieving and transport of water through aquaporin channels. 57,58 The removal of free water is greatest during the initial 30–60 min of each exchange. If hypernatremia develops, consideration should be given to extending the dwell time if solute clearance allows or lowering the concentration of glucose in the dialysis solution.…”

Section: Rationalementioning

confidence: 99%

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics)

Nourse

Cullis²,

Finkelstein

et al. 2021

Perit Dial Int

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Peritoneal dialysis (PD) for acute kidney injury (AKI) in children has a long track record and shows similar outcomes when compared to extracorporeal therapies. It is still used extensively in low resource settings as well as in some high resource regions especially in Europe. In these regions, there is particular interest in the use of PD for AKI in post cardiac surgery neonates and low birthweight neonates. Here, we present the update of the International Society for Peritoneal Dialysis guidelines for PD in AKI in paediatrics. These guidelines extensively review the available literature and present updated recommendations regarding peritoneal access, dialysis solutions and prescription of dialysis. Summary of recommendations 1.1 Peritoneal dialysis is a suitable renal replacement therapy modality for treatment of acute kidney injury in children. (1C) 2. Access and fluid delivery for acute PD in children. 2.1 We recommend a Tenckhoff catheter inserted by a surgeon in the operating theatre as the optimal choice for PD access. (1B) (optimal) 2.2 Insertion of a PD catheter with an insertion kit and using Seldinger technique is an acceptable alternative. (1C) (optimal) 2.3 Interventional radiological placement of PD catheters combining ultrasound and fluoroscopy is an acceptable alternative. (1D) (optimal) 2.4 Rigid catheters placed using a stylet should only be used when soft Seldinger catheters are not available, with the duration of use limited to <3 days to minimize the risk of complications. (1C) (minimum standard) 2.5 Improvised PD catheters should only be used when no standard PD access is available. (practice point) (minimum standard) 2.6 We recommend the use of prophylactic antibiotics prior to PD catheter insertion. (1B) (optimal) 2.7 A closed delivery system with a Y connection should be used. (1A) (optimal) A system utilizing buretrols to measure fill and drainage volumes should be used when performing manual PD in small children. (practice point) (optimal) 2.8 In resource limited settings, an open system with spiking of bags may be used; however, this should be designed to limit the number of potential sites for contamination and ensure precise measurement of fill and drainage volumes. (practice point) (minimum standard) 2.9 Automated peritoneal dialysis is suitable for the management of paediatric AKI, except in neonates for whom fill volumes are too small for currently available machines. (1D) 3. Peritoneal dialysis solutions for acute PD in children 3.1 The composition of the acute peritoneal dialysis solution should include dextrose in a concentration designed to achieve the target ultrafiltration. (practice point) 3.2 Once potassium levels in the serum fall below 4 mmol/l, potassium should be added to dialysate using sterile technique. (practice point) (optimal) If no facilities exist to measure the serum potassium, consideration should be given for the empiric addition of potassium to the dialysis solution after 12 h of continuous PD to achieve a dialysate concentration of 3–4 mmol/l. (practice point) (minimum standard) 3.3 Serum concentrations of electrolytes should be measured 12 hourly for the first 24 h and daily once stable. (practice point) (optimal) In resource poor settings, sodium and potassium should be measured daily, if practical. (practice point) (minimum standard) 3.4 In the setting of hepatic dysfunction, hemodynamic instability and persistent/worsening metabolic acidosis, it is preferable to use bicarbonate containing solutions. (1D) (optimal) Where these solutions are not available, the use of lactate containing solutions is an alternative. (2D) (minimum standard) 3.5 Commercially prepared dialysis solutions should be used. (1C) (optimal) However, where resources do not permit this, locally prepared fluids may be used with careful observation of sterile preparation procedures and patient outcomes (e.g. rate of peritonitis). (1C) (minimum standard) 4. Prescription of acute PD in paediatric patients 4.1 The initial fill volume should be limited to 10–20 ml/kg to minimize the risk of dialysate leakage; a gradual increase in the volume to approximately 30–40 ml/kg (800–1100 ml/m2) may occur as tolerated by the patient. (practice point) 4.2 The initial exchange duration, including inflow, dwell and drain times, should generally be every 60–90 min; gradual prolongation of the dwell time can occur as fluid and solute removal targets are achieved. In neonates and small infants, the cycle duration may need to be reduced to achieve adequate ultrafiltration. (practice point) 4.3 Close monitoring of total fluid intake and output is mandatory with a goal to achieve and maintain normotension and euvolemia. (1B) 4.4 Acute PD should be continuous throughout the full 24-h period for the initial 1–3 days of therapy. (1C) 4.5 Close monitoring of drug dosages and levels, where available, should be conducted when providing acute PD. (practice point) 5. Continuous flow peritoneal dialysis (CFPD) 5.1 Continuous flow peritoneal dialysis can be considered as a PD treatment option when an increase in solute clearance and ultrafiltration is desired but cannot be achieved with standard acute PD. Therapy with this technique should be considered experimental since experience with the therapy is limited. (practice point) 5.2 Continuous flow peritoneal dialysis can be considered for dialysis therapy in children with AKI when the use of only very small fill volumes is preferred (e.g. children with high ventilator pressures). (practice point)

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“…In ESRD patients undergoing renal replacement therapy, these toxins are eliminated by dialysis and with preserved RRF also by native kidneys. Weekly elimination of urea (expressed as total weekly clearance of urea, twKt/V) and creatinine (expressed as total weekly clearance of creatinine, twCCr L/week/1.73 m 2 ) is calculated in children according to [ 12 , 13 ].…”

Section: Definition and Measurements Of Residual Renal Functionmentioning

confidence: 99%

“…Advantages of PD over hemodialysis in pediatric patients are related to a twofold higher peritoneal membrane surface per kilogram of body mass compared to adults, difficulties related to creation and maintenance of adequate vascular access for hemodialysis in the youngest patients, elimination of pain related to punctures of the arteriovenous fistula, and no need for anticoagulant use. A greater degree of patient freedom with this approach allows home dialysis therapy, regular schooling or kindergarten attendance, and engaging in normal everyday life activities [ 13 ]. Peritoneal dialysis is the initial approach to renal replacement therapy in 53.1% of children below 15 years of age in Europe [ 65 ], 45% of children below 18 years of age in the North America [ 66 ], and 39% of children below 18 years of age in Australia and New Zealand [ 67 ].…”

Section: Peritoneal Dialysis In Childrenmentioning

confidence: 99%

Residual Renal Function in Children Treated with Chronic Peritoneal Dialysis

Roszkowska‐Blaim

Skrzypczyk

2013

The Scientific World Journal

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Residual renal function (RRF) in patients with end-stage renal disease (ESRD) receiving renal replacement therapy is defined as the ability of native kidneys to eliminate water and uremic toxins. Preserved RRF improves survival and quality of life in adult ESRD patients treated with peritoneal dialysis. In children, RRF was shown not only to help preserve adequacy of renal replacement therapy but also to accelerate growth rate, improve nutrition and blood pressure control, reduce the risk of adverse myocardial changes, facilitate treatment of anemia and calcium-phosphorus balance abnormalities, and result in reduced serum and dialysate fluid levels of advanced glycation end-products. Factors contributing to RRF loss in children treated with peritoneal dialysis include the underlying renal disease such as hemolytic-uremic syndrome and hereditary nephropathy, small urine volume, severe proteinuria at the initiation of renal replacement therapy, and hypertension. Several approaches can be suggested to decrease the rate of RRF loss in pediatric patients treated with chronic peritoneal dialysis: potentially nephrotoxic drugs (e.g., aminoglycosides), episodes of hypotension, and uncontrolled hypertension should be avoided, urinary tract infections should be treated promptly, and loop diuretics may be used to increase salt and water excretion.

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Peritoneal Dialysis in Children

Cited by 18 publications

References 384 publications

Peritoneal Dialysis for Acute Kidney Injury

Peritoneal Dialysis for Acute Kidney Injury

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics)

Residual Renal Function in Children Treated with Chronic Peritoneal Dialysis

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